Category: Data & science

Dissection of Prof Hendy model presented at Ardern conference 23/9/21

We do not hold this type of modelling in high regard.

First of all, it is myopically focused on reducing harm from Covid-19. It is hard to understand the utility of presenting such results without context.

There is no mention that the average age of death of those predicted to die will be about the same as our life expectancy. To put it slightly differently, most of those forecast 7,000 deaths were on average likely to die that year with or without SARS-CoV2. About 35,000 people die each year in New Zealand and half of them are over 80 years old. https://figure.nz/chart/SOBvdb4q1OXAaoLM-H9S6kQLicMFxLijb

There is not a single mention in any of the Matatini documents of deaths among Covid-vaccinated people. Even Pfizer’s latest trial shows more deaths in the vaccinated group compared to the unvaccinated. https://www.nejm.org/doi/full/10.1056/NEJMoa2110345.

It is misinformation to build a model that generates a result used to promote vaccination without mentioning that up to half of the predicted deaths will be among vaccinated people.

A quote from the study:

“During the blinded, placebo-controlled period, 15 participants in the BNT162b2 group and 14 in the placebo group died; during the open-label period, 3 participants in the BNT162b2 group and 2 in the original placebo group who received BNT162b2 after unblinding died.”

There is a very concerning issue in this Pfizer trial – that the vaccine itself might be responsible for some of the deaths in the trial, not Covid.  It is not very convincing that there was a 40% (20/14) increased overall death rate in the vaccinated and eventually vaccinated group compared to controls.  While the Pfizer paper asserts that the deaths in vaccinated people had nothing to with the vaccine, it does not provide evidence.

This is a consistent trend across all covid-19 vaccine studies

https://newsrescue.com/wp-content/uploads/2021/08/us-covid19-vaccines-proven-to-cause-more-harm-than-good-based-on-pivotal-clinical-trial-data-analyzed-using-the-proper-scientific-1811.pdf

The predictions from the study that high vaccination uptake will result in reduced harm from covid-19 are not borne out by real world experience, such as from Israel: https://www.timesofisrael.com/health-ministry-chief-says-coronavirus-spread-reaching-record-heights/

It is clear that high levels of vaccination coverage have not lived up to the hope indicated from the results of the trials.

The Covid policy responses modeled in the work are conventional ones already proven ineffective over the past 18 months in other countries. The model does not attempt to work out results of using other strategies, some now being attempted in countries such as India. https://www.thegatewaypundit.com/2021/09/huge-uttar-pradesh-india-announces-state-covid-19-free-proving-effectiveness-deworming-drug-ivermectin/

For example, meta-analysis of trials (conventionally considered high level evidence) support the use of Ivermectin to reduce covid-19 mortality. https://lnkd.in/g3eMbaGU

The use of models without comparing or contrasting with actual trials, amounts to misinformation. Trials are conventionally considered stronger evidence than modelling studies.

It is deeply worrying that the government is using models to justify responses, when we have actual evidence and trials from the past 18 months of experience in other countries. It feels disturbingly reminiscent of the now widely discredited models used by other Western Governments very early in the pandemic.

What Prof Hendy gets wrong

COMMENTS ON THE VIEWS OF PROFESSOR HENDY

Dr Martin Lally

Director, Capital Financial Consultants Ltd

lallym@xtra.co.nz

Professor Shaun Hendy is another prominent adviser to the New Zealand government on covid-19 issues.  Like Professor Baker, he combines frequent commentary via popular media in support of lockdowns with papers written (with numerous co-authors) in the academic style.  However, unlike Professor Baker, he does not seem to have done any prior research in epidemiology (he is a Professor of Physics).  His epidemiological work starts with his first covid paper, which was posted to a website on 25 March 2020:

https://www.tepunahamatatini.ac.nz/2020/03/26/suppression-and-mitigation-strategies-for-control-of-covid-19-in-new-zealand/

Table 2 of the paper presents predictions of the death tolls in New Zealand from a range of possible control strategies.  No control yields predicted deaths of 83,000 (1.67% of the population).  Case isolation and quarantining of members of their households reduces this to 62,500 (1.25% of the population).  Adding population-wide social distancing reduces this to 3,000 (0.06% of the population), and adding school and university closures reduces it further to 20.  On page 7, they consider a strategy they describe as “mitigation”, with a predicted death toll of 25,000 (0.508% of the population), and involving a combination of periods of low control (case isolation plus household quarantining) with periods of high control (add population-wide social distancing and school and university closures) as required to keep the number of cases within the capacity of the hospital system.  None of these strategies correspond to mitigation as defined in the 23 March published paper by Professors Baker, Wilson and Blakely (isolation of the over 60s). The most interesting features of the Hendy paper are:

1. The worst case scenario (in which no control measures are instituted) was 83,000 dead (1.67% population mortality rate, as per their Table 2).  By contrast, the worst case death toll (with no control measures) in the many papers of Professors Baker and Wilson (who were the most significant advisers to the government at this time) was 30,600 (in the Baker et al paper of 23 March).  Hendy et al do not even cite this paper, which predates theirs, let alone explain why their worst case figure is almost three times that of Baker et al.  The usual practice in academic work is to cite relevant existing work, and explain why your approach is better.  The need for this is amplified by the fact that none of the Hendy et al co-authors is an epidemiologist, while all co-authors of the Baker et al paper are.

2. The set of control strategies examined did not include lockdown (closing down all but essential businesses as well as all the restrictions described by Hendy), and yet Hendy et al concluded that deaths could be limited to 20 in the highest control state examined by them.  The only places of work that are closed down in any of the control states in Hendy’s Table 2 are schools and universities.  Since it took lockdowns on repeated occasions to achieve New Zealand’s covid death toll to date of 27, Hendy’s belief that this could be achieved without lockdowns would seem to have been far too optimistic. Interestingly, in Baker et al’s paper of 23 March, the authors do not define the restrictions involved in their high control scenario (which they call “eradication”) but the lack of specification of the restrictions at least allows for the possibility that it involved lockdowns.

3. None of the control strategies examined by Hendy et al corresponds to Level 3 or Level 4, despite these levels having been defined by the government on 21 March 2020, which was four days before the Hendy paper was released.  So, by the time the paper was released, it was already superseded by the events of 21 March.

4. The costs of adopting different control strategies are not even mentioned, let alone quantified.  Nor was there any conversion of predicted deaths to life years lost, nor valuation of this in accordance with standard methodology in the medical literature.  Again this contrasts with the Baker et al paper.

The next significant paper by Hendy et al was on 21 October 2020 and was concerned with the economic costs of the Level 3 August 2020 Auckland lockdown relative to those of an alternative Level 4 lockdown:

https://www.tepunahamatatini.ac.nz/2020/11/16/economic-comparison-of-the-use-of-alert-levels-3-and-4-for-aucklands-august-outbreak/

The paper assumes adoption of the government’s elimination strategy and is only concerned with the question of whether Level 4 restrictions would have been more or less costly (in lost GDP) than the Level 3 restrictions actually adopted in Auckland (Level 4 restrictions cost more per day than Level 3 restrictions but are likely to end sooner).   They find a modest such advantage to Level 4, because the expected time in lockdown to reach their epidemiological target is shorter in Level 4, which more than compensates for the higher costs per day.  This seems to be the first paper from Hendy et al that considers the costs of competing policies, but none of the co-authors appears to have any expertise in economics. The most interesting features of the paper are:

1. Despite considering the costs of these two options, the paper does not accord with the standard methodology in the medical literature of assessing the comparative deaths of the two options and converting this to a cost per QALY saved.

2. The data in their Tables 1 and 2 does not reconcile.  For example, Table 1 states that the cost per day in Level 3 is $57m, Table 2 gives expected days under Level 3 restrictions as 23, implying a cost of $1.3b, but Table 2 gives a cost of $1.8b instead.  The same problem applies to the Level 4 restrictions.  I raised this point with the lead author (Rachel Binny) on 17 November and received a reply from Professor Hendy but he did not address this issue over the course of several emails (in which I reminded him about the point).  I therefore presume that Table 2 is in error.

3. Page 8 of the paper says “Figure 2B shows the economic cost of the outbreak for a particular probability of elimination in the cases where the elimination was successful.”  This is not correct. The Figure is premised on exiting lockdown when cases have fallen to a level at which the probability of elimination has fallen to a particular level, and shows the economic cost for the expected lockdown period for a particular probability of elimination. Whether elimination was subsequently achieved is irrelevant to this calculation.  I also raised this point with the lead author (Rachel Binny) on 17 November and received a reply from Professor Hendy but he did not address this issue over the course of several emails (in which I reminded him about the point).

4. The authors acknowledge that their analysis does not consider the “..longer term economic costs of the measures..” (Executive Summary) and that “These factors may take the analysis to a different conclusion.” (page 10).  What then is the usefulness of the analysis?

5. Despite limiting themselves to the question examined, they note in passing that cost benefit analyses such as those performed by Heatley (2020) and Lally (2020) “…might be useful for informing a mitigation strategy but are not useful for a decision maker considering or following an elimination strategy” (pp. 4-5).  This seems to be accepting that cost-benefit analysis might be appropriate for choosing between mitigation and elimination strategies, as was the focus of Lally (2020), whilst denying its usefulness in choosing between Level 3 and 4 restrictions.  However, even if one has decided on an elimination strategy, for whatever reasons, there are competing variants of it, as Hendy et al recognises in comparing a Level 3 and Level 4 response to the Auckland outbreak, and cost-benefit analysis should also be used to choose between them, as Heatley does and Hendy et al do not.

6. Hendy et al refer again later to the cost-benefit analyses of Heatley and Lally, and state that “Combining our approach….with these more in-depth economic analyses may be useful in informing future responses.” (page 10). This seems to be accepting that cost-benefit analysis may be useful for choosing between Level 3 and 4 restrictions, thereby undercutting the contrary claim quoted in the previous point.

7. The equivocal comments by Hendy et al quoted in the last two points (“may” or “might”) suggest a lack of confidence on the part of the authors about basic economic issues that anyone offering policy advice ought to be confident about. This is understandable in view of none of the authors having any apparent expertise in economics, but it is harder to understand why they would offer policy advice about matters that they are so uncertain about.

 

Vaccination rates – some thoughts on modelling

There’s been some hysterical modellers claiming that even
with high rates of Pfizer vaccination, there will still be a large number of deaths.
Ironically, their models have opened the way in New Zealand to questioning the value of Covid vaccines.
We don’t need notoriously unreliable models, because we’ve got actual trial data. Trial evidence is superior to all other epidemiological evidence, and particularly so for projected models. We shouldn’t be relying on models now that we have so much observed data, including trials.
The latest Pfizer data reveals that there is a 7% increase in the overall fatality rate in vaccinated people compared to the unvaccinated.
As we said in a recent post:
The best evidence of overall effect on death comes from the latest update of the Pfizer trial which shows slightly more overall deaths (15/21,926) occurred in the vaccinated group than in controls (14/21,921). This is important, since the outcome doesn’t just count successes (reduced covid ‘cases’), but also includes the possibility of vaccine harm, evaluating the effect of the vaccine on overall survival. This means the best evidence thus far indicates a 7% increase in risk of death, comparing the vaccinated to the unvaccinated. Yes, the numbers are small, and these results are compatible with a wide range of vaccine effects, but it seems strange that this important information is relegated to the study appendices and is absent from the summary. Most of us are more interested in our overall longevity, rather than being solely focused on avoiding covid-19. The Prime Minister’s claim (52’:27”) that the vaccine is “saving lives” is sounding hollow, from the best possible epidemiological evidence: Pfizer’s own trial.
Another publication points out that more severe adverse outcomes occurred in the treated than the untreated in all three vaccine trials.
 
https://newsrescue.com/wp-content/uploads/2021/08/us-covid19-vaccines-proven-to-cause-more-harm-than-good-based-on-pivotal-clinical-trial-data-analyzed-using-the-proper-scientific-1811.pdf
 
The claims of the New Zealand modellers and Prof. Rod Jackson ignore important facts:
 
1. The age distribution of deaths with Covid is about the same as background.
 
https://www.covidplanb.co.nz/our-posts/is-new-zealands-covid-19-story-past-its-use-by-date/
2. Delta is not much different
It is not clear that ‘Delta’ is worse than any other form of Covid. https://www.medrxiv.org/content/10.1101/2021.09.02.21263014v1
3. Vaccines and lockdowns are not working
Jackson states that there are only two ways to ‘deal with delta: lockdowns and vaccines’.
As we have been saying from the start, lockdowns don’t work. https://www.nature.com/articles/s41598-021-84092-1
Vaccines have not been successful in halting the Delta variation.
https://www.businessinsider.com.au/israel-brings-back-covid-19-restrictions-despite-vaccine-success-2021-8?op=1&r=US&IR=T
With all this data available, why are we still living in fear?
While it was easy for authorities, media, and professional and amateur worriers to start the irrational fear that has dominated that past 18 months, it has been extremely hard to stop it.
Many of those who started it, and modellers were chief among them, don’t yet want it to stop.

Notes on Covid vaccines in young people

There have been reports of deaths in New Zealand teenagers within weeks of being administered with the Comirnaty product.

It is concerning that there has been a concentration of unusual fatal events in teenagers in a short space of time, coinciding with the roll-out of the experimental product with only provisional Medsafe approval.

There’s not yet enough information to make conclusions on these specific cases, but there are reasons for concern.

The first is medical. The timing and the type of health event, raises the chance of connection – at the very least to the point of acknowledgement and urgent investigation.

Heart attacks or myocardial infarctions, to use the technical term, are exceedingly rare in teenagers.[1] Generally, only case-reports are described and they often are associated with other factors, such as illicit drug use.[2] Similarly, another possibility, community acquired vein clots in otherwise well children are extremely rare. A search of cases at The Royal Children’s Hospital in Melbourne from 2007 to 2015 yielded only eleven.[3] The term ‘heart attack’ may refer to myocarditis or heart muscle inflammation, which has been linked to the vaccine by the government’s own medicine regulator.[4]

It is not clear whether proper investigations have taken place. The lack of interest is at odds with growing evidence of harm in young people after the Pfizer mRNA injection overseas. One study highlights a case-series of heart inflammation in 13 US adolescents in Washington state[7] with a median onset three days after the vaccine. A cohort study from Spain shows a three-fold increased risk of any vein clot after the second dose, compared to unvaccinated people.[8] Overseas reports of injury post-vaccination are like those described here in NZ. Singapore media described a case of heart inflammation as a ‘heart attack’ in a 16-year-old. Their government has agreed to pay the teenager $225,000 in compensation.[9]

We need to remember that the risk of death from covid-19 in teenagers is almost zero, as is their overall risk of death in this country.[11] The evidence relating to young people dying within a fortnight of a vaccine must not be hastily swept under the carpet

That the deaths are being downplayed is the second concern. The willingness of authorities to act and say there is no connection, when they don’t have or provide information, is a very serious breach of their duty. It is an awful risk to take.

The response from government officials has been surprisingly dismissive.[5] In a recent newspaper article, director-general of health Dr Ashley Bloomfield stated that if there was “any possibility” of such a link, a health professional would have reported it. This is an extremely weak form of ‘argument from authority’ (essentially Bloomfield said that since no authority has reported it, it didn’t happen).

The principal of another school stated that he understood the death was “due to a suspected heart attack – not COVID”. This excuse sidesteps the core question, and is typical of preparedness to use non-experts saying silly things when they back the pro-Covid vaccine narrative.

Another article quoted the Prime Minister: Jacinda Ardern said there have been no deaths to any teenagers in New Zealand related to getting vaccinated and encouraged New Zealanders to continue getting vaccinated.[6]

Further information about these cases is clearly in the public interest. Were autopsies carried out? What were their results? What was the working diagnosis? A full investigation and disclosure of the evidence for vaccine harm is surely the only prudent response given the gravity of these events. Are there other deaths after the injection that are not reported?

This cluster of deaths should make us all take a sober look at the real risks of this experimental injection and dig deeper into the details of these deaths, as our next generation depends on us for guidance.

[1] https://sma.org/southern-medical-journal/article/st-elevation-myocardial-infarction-in-a-teenager-case-report-and-review-of-the-literature/

[2] https://www.jpgmonline.com/article.asp?issn=0022-3859;year=2006;volume=52;issue=1;spage=51;epage=56;aulast=Menyar

[3] https://www.sciencedirect.com/science/article/pii/S0049384815302206?casa_token=MnC0DN9UE84AAAAA:ZliIK8OdPptf_3EgbrVCSPYJBg8dm84zxYMleFsIpoew3SuZDwx5jCtD10a1sMWnnxNioguXZbh6

[4] https://www.medsafe.govt.nz/safety/Alerts/comirnaty-myocarditis.asp

[5] https://www.nzherald.co.nz/nz/covid-19-delta-outbreak-teenagers-death-not-related-to-pfizer-jab-prime-minister-says/7CFYHIGX2YYE3ACK3R32HTN424/

[6] https://www.newshub.co.nz/home/new-zealand/2021/09/covid-19-jacinda-ardern-says-auckland-teenager-s-death-not-related-to-pfizer-vaccine.html

[7] https://www.jpeds.com/article/S0022-3476(21)00665-X/fulltext

[8] https://www.medrxiv.org/content/10.1101/2021.07.23.21261036v2

[9] https://nz.news.yahoo.com/teen-heart-attack-after-vaccine-dose-receive-225000-094655532.html

[11] https://www.nejm.org/doi/full/10.1056/NEJMc2026670

Bridle busts open nonsensical vaccine attitudes and rules

A passionate and dispassionate dissection of Covid ‘vaccines’, and ridiculous mandates and use of them by authorities, from Byram Bridle, Associate Professor of Viral Immunology, at the
University of Guelph.

2021-09-17 – Open letter to the president of the U of G_B.Bridle

Vaccine targets no use in Covid-19 policy

14/09/2021

Many areas of the world are now in a race to achieve high coverage of covid-19 vaccination. Some commentators in New Zealand are now criticising the government for not rolling out  fast enough. Given the high efficacy of many vaccines, this seems like a sensible strategy, but is it?

The government recently asked some of New Zealand’s epidemiology experts “Is an elimination strategy still viable as international travel resumes or are we going to need to accept a higher level of risk and more incidence of COVID in the community”. The specialists concluded that: “There is no doubt that this strategy has served us well”, comparing deaths in New Zealand attributed to covid-19 of 26 to 10,000 in Scotland. The way out was through high levels of vaccination. The document assumes that elimination is the ‘optimal’ strategy and further incursions, we are assured, will be ‘stamped out’ as we achieve high levels of vaccine induced immunity.

Will this really eventuate? In terms of rapid vaccine rollouts, Iceland is a counter example. Icelanders have now vaccinated 69 or 81% of their population, depending on whether you consider the whole population or only those eligible for vaccination (12 years and over). Almost all Iceland’s older generations are now vaccinated (99% coverage of 70 to 79 years), yet the younger generation has slightly lower coverage (78% of 30 to 39 years).  However, the vaccination records of covid-19 cases there tells another story: 73% of cases are fully vaccinated. This figure is inconsistent with the trial evidence of efficacy of the vaccine being 95% in reducing symptomatic infections (95% confidence interval: 90.3 to 97.6%). If this efficacy were correct, covid cases would be expected to only yield a small fraction of people with records of full-immunisation [(69% – 95% * 69%)/(1 – 69% * 95%) = 10%]. As almost three-quarters (73%) of recent cases in Iceland are fully vaccinated the efficacy obtained in the trial does not match the reality of the roll-out.

Others are noticing similar results: a recent case-series in the US also showed 74% of cases were vaccinated, with PCR cycle threshold values, roughly assumed to be equivalent to infectivity, similar in vaccinated and unvaccinated cases.

A case is being made for continuing vaccination since deaths may be prevented in those vaccinated. However, in the UK, a Public Health England recent report shows that of all dominant delta variant cases occurring from 2 February to 3 August 2021 (n = 300,010), 15.7% (47,008/300,010) were fully vaccinated compared to 50.3% (151,054/300,010)  unvaccinated. The remainder were either partially vaccinated or their status was unknown. A total of 741 deaths occurred in the delta cohort (0.25%; 741/300,010) within 28 days of testing PCR positive, with 90% of deaths (670/741) occurring in those aged over 50 years (figure; five unlinked cases are removed). The outer grey square represents the total cohort who tested positive for delta variant, with the blue rectangle the cases aged less than 50 years, the beige those who had been fully vaccinated, the dark green those who were hospitalised and the light green the deaths. One can immediately appreciate that deaths are few in the delta cohort and that most people do not need hospital treatment, even in the over 50 age group. This means that delta is hardly the “game changer” the Prime Minister has talked of.

Analysis of the delta cohort points to differential associations between exposure to the vaccine and death within a month. When the cohort is divided by age, deaths associated with covid-19 are 1.57 times (95% confidence interval (CI): 0.85 to 2.89, not significant) more likely in the vaccinated group under 50 years, compared to unvaccinated, whereas in the older bracket the vaccinated are 70% less likely to die from covid-19 compared to the unvaccinated (95% CI: 84 to 64%).  The vaccine’s ability to prevent covid-19 deaths in younger age groups among people with the delta variant is certainly questionable from these data. It must also be remembered that these calculations are crude in the sense that they do not account for comorbid status of delta ‘cases’.

Figure. Scaled rectangle diagram, illustrating the fatality proportion of the UK delta variant case cohort, by vaccination status, age and need for hospital care. Some counts of small cell values and those with uncertain vaccination status (n = 31,841) have been omitted. This includes 13 deaths occurring in the ‘fully vaccinated’ under 50 years, 56 in the ‘unvaccinated’ group under 50 and 7 were unlinked, making 741 total deaths.

The best evidence of overall effect on death comes from the latest update of the Pfizer trial which shows slightly more overall deaths (15/21,926) occurred in the vaccinated group than in controls (14/21,921). This is important, since the outcome doesn’t just count successes (reduced covid ‘cases’), but also includes the possibility of vaccine harm, evaluating the effect of the vaccine on overall survival. This means the best evidence thus far indicates a 7% increase in risk of death, comparing the vaccinated to the unvaccinated. Yes, the numbers are small, and these results are compatible with a wide range of vaccine effects, but it seems strange that this important information is relegated to the study appendices and is absent from the summary. Most of us are more interested in our overall longevity, rather than being solely focused on avoiding covid-19. The Prime Minister’s claim (52’:27”) that the vaccine is “saving lives” is sounding hollow, from the best possible epidemiological evidence: Pfizer’s own trial.

The policy response to the recent surge in cases in Iceland is to extend vaccination to pregnant women and impose further restrictions. The UK, in contrast, is dropping restrictions, despite a recent spike in overall case-numbers.  As New Zealand is once again thrown into costly lockdowns, we need to ask whether it is appropriate, given the evidence.

We now have a group of scientists advising the government that cannot see any other strategy apart from elimination as ‘viable’ or ‘optimal’. This is understandable, as they have committed the country to this course of action, one that has cost us at least NZ$50 billion. We must now recognize that other courses of action are viable. Sweden, Florida, and Texas demonstrate this. Analysis of excess mortality in Sweden for 2020 has shown a 3 to 8% increase from background which are attributable to past mild influenza seasons. The rush to vaccinate must now be balanced by the questionable efficacy of vaccines demonstrated in Iceland, the accumulating evidence of vaccine-related adverse effects, including the 350 serious reactions on government websites. The enthusiasm for more lockdowns must also be questioned, given evidence of  business closures, queues at food banks and the extra 43,000 kiwis on jobseeker support since March 2020.

As we said from early 2020, the path forward lies not in a medical intervention, but rather in a realistic assessment of the threat posed by the virus, based on such evidence as the distribution of age of death with covid-19 being similar to background mortality. Our efforts should be best focused on protecting the most vulnerable, implementing early treatment protocols, increasing capacity in our hospitals, while the majority of those of working age and younger people return to normal life. Overseas data clearly now show that vaccines are not a way out.

Reflections on the Skegg report pt.2

Dr Martin Lally

Director, Capital Financial Consultants Ltd

lallym@xtra.co.nz

In an earlier comment on the Skegg Report, I noted that the authors did not provide any empirical analysis in support of their conclusion that the elimination strategy should continue to be pursued in New Zealand.  However, in para 6, they did refer to a published paper that concluded that an elimination rather than a mitigation strategy has to date yielded the best outcomes for health (lower covid death rate), the economy (lower GDP losses) and civil liberties (lower average government restrictions). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00978-8/fulltext?

This paper compares the average death rates, GDP losses and restrictions on movement in the five OECD countries that consistently aimed for elimination with the rest that did not.  Everything is claimed to be better in the first group: a lower average death rate, smaller average GDP losses, and lower average restrictions on civil liberties.  Elimination is defined as “Maximum action to control SARS-CoV-2 and stop community transmission as quickly as possible.”  The five OECD countries claimed by them to have done so are Australia, Iceland, Japan, New Zealand, and South Korea.

This seems like the Holy Grail; if true, there would be no need for trading off liberty and GDP losses for lower covid deaths, and therefore no need for a cost-benefit analysis.  However, as usual, if it seems too good to be true, it isn’t.  The first problem is that the five countries that supposedly undertook the “maximum action to control SARS-CoV-2 and stop community transmission as quickly as possible” include Iceland, Japan and South Korea.  At the very least, maximum action to control covid as quickly as possible would involve border closures and lockdowns.  However, none of these three locked down and Iceland additionally did not even close its borders.

I conveyed this concern to the lead author of the paper (Professor Oliu-Barton), and he replied that their classification of countries relied in part on the ratio of the Stringency Index to the covid deaths during the period when the covid deaths were very low, with the five countries in question having high values for this ratio. This seemed rather subjective so I asked for further details to see if I could reproduce their result (which is fundamental to the credibility of scientific research).  I have yet to receive a reply to that.  Nevertheless, the following seems clear.

  1. The authors are not measuring the extent to which countries took the “maximum action to control covid” but are instead measuring how quicklygovernments reacted.  So, the conclusion of the paper (that elimination is superior to mitigation on all dimensions) is not supported by their analysis.  Instead, their analysis supports the conclusion (at most) that acting quickly produces the best outcomes on all dimensions.  Even this conclusion may be too strong because:
  2. The analysis in their paper considers only one possible variable that could explain deaths, economic losses and loss of liberties: how fast a government acts. They identify the five fastest movers in the OECD and find that these countries had on average much lower death rates than the other OECD countries (and other benefits), and then attribute this to them moving quickly.  However, had they instead conjectured (very reasonably) that being an island mattered, and identified the island nations amongst their OECD set, they would have found that these island nations were exactly the same five countries that they identify as the fastest movers (South Korea is effectively an island too), and then found their average death rate was much less than the other OECD countries, and would then presumably have attributed this to them being islands.  So, their paper would then have been entitled “Being an Island Creates Best Outcomes for Health, the Economy and Civil Liberties.”  Neither of these two approaches would be satisfactory.  Since death rates may be driven by many variables, a multivariate analysis is essential.  In my own analysis I used multiple regression, and found the following variables to be statistically significant in explaining death rates for countries: population density (low is good), population (low is good), whether it is an island (good), and the date of its first covid death (later is better, to provide more time for preparation).  I also found that the last variable was very closely correlated with how quickly a government acted, measured by the time interval between a country reaching 54% on the Oxford Stringency Index for government restrictions and the date of its first death (high values are best). See pp. 4-8 of:

https://www.medrxiv.org/content/10.1101/2021.07.15.21260606v1

  1. Conclusions from statistical analysis require tests for statistical significance.  The authors do not perform any such tests.  This is particularly unsatisfactory in respect of their graph of GDP outcomes for their two sets of countries, which are very similar.  Had they conducted statistical tests, they might have found that economic outcomes were statistically indistinguishable between the two groups, and therefore avoided making the claim that a particular type of government policy produced the “best outcomes for the economy”.
  2. The analysis in their paper uses classification data on government policy (countries are classified as fast movers or not) rather than numerical data.  The latter is more powerful if it can be done, because it avoids the somewhat arbitrary dividing line between the two groups and uses inter-group variation as well as variation between the groups. Furthermore, it could be done in this case.  For example, in my analysis, I quantified the speed of government actions by the time interval from reaching 54% on the Oxford Stringency Index until the first covid death.  It may be that the authors used classification data because their assessment of government policy was subjective.  If so, then there is the further problem that they may have been subconsciously biased towards judging these five countries to be the fastest movers because they already knew that they had the lowest death rates in the OECD data set. Such subconscious bias risks turning their analysis into advocacy rather than scientific analysis.  In addition, using classification data requires them to choose the dividing line between the two groups of countries, and this too exposes them to subconscious bias in choosing to include only five countries in the elimination group.
  3. Any analysis on whether government policy has favourable effects on covid death rates is exposed to the problem of reverse causality, i.e., government decisions may have been driven by observation of the death rate as well as affecting the death rate. This should have been tested for. The authors do not conduct any such tests.  By contrast, I conduct such tests in the Appendix to my paper.
  4. Drawing conclusions about which government actions produce the best outcomes on the basis of a cross-country analysis, as the authors do, can at best only offer conclusions that are valid in general, i.e., they might be true for 60% of countries but not for the other 40%.  Since policy is made by individual countries, the conclusions would then be worthless to individual governments.  The better approach is to conduct a cost-benefit analysis for each individual country, as I have done in my paper (and in a parallel analysis for Australia).

In summary, the article is not measuring the thing it claims to be measuring, and the analysis fails to consider more than one explanatory variable, and it presents no tests of statistical significance, and it uses classification data rather than numerical data, and it conducts no tests of reverse causality, and its results have no value for an individual government.

The paper should not then have been relied upon by the Skegg Committee.  In fact, it is hard to believe that the members of that Committee even read the paper; had they done so, they would surely have noticed that three of the five countries claimed to be following an elimination strategy did not even lock down.  Had they noticed that, and then contacted the authors of the paper for an explanation, and received the explanation I did, it would then have been apparent that the article was not in fact assessing the merits of elimination but the merits of moving quickly.  Moving quickly is good, as the article finds (and I do too) but it does not imply that elimination is better than (say) not locking down and taking other mitigation measures to minimise deaths.  If your house is burning, it may not be clear what action you should take to fight the fire or mitigate the damage but it is obvious that any action you take should be taken quickly.  Likewise the sun rises in the east.

The Skegg Report contains one other piece of empirical evidence on outcomes to date.  In para 8, the report notes that the benefits of New Zealand’s approach can be illustrated by comparing it with Scotland, with much the same population but which experienced 10,000 deaths compared to our 26.  Cherry picking one country is advocacy, not scientific analysis.  Furthermore, if one is going to cherry pick Scotland, one would have to ask how Scotland would have fared had it followed exactly the same policy as New Zealand.  Unlike New Zealand, Scotland has a land border with a place (England) that followed a much less stringent approach than us, and England in turn is separated from the European continent by only 20 miles, with a tunnel connecting them.  With these natural disadvantages, it is unlikely that Scotland would have experienced 26 deaths had it followed exactly the same policy as New Zealand.  What then is the point of citing Scotland’s deaths, other than to suggest (wrongly) that our very low death rate was due entirely to policy and not also to geography?

 

BMJ critiques Pfizer data: efficiacy waning

Here’s at link to Peter Doshi’s devastating BMJ critique of the Pfizer vaccine data. Which leaves the Israel experience as our most reliable current guide – and Israel is reporting efficiacy below 40%.
In short, there is “no reported data past 13 March 2021, unclear efficacy after six months due to unblinding, evidence of waning protection irrespective of the Delta variant, and limited reporting of safety data. (The preprint reports “decreased appetite, lethargy, asthenia, malaise, night sweats, and hyperhidrosis were new adverse events attributable to BNT162b2 not previously identified in earlier reports,” but provides no data tables showing the frequency of these, or other, adverse events.)
https://blogs.bmj.com/bmj/2021/08/23/does-the-fda-think-these-data-justify-the-first-full-approval-of-a-covid-19-vaccine/

Protocol for re-opening New Zealand society

24/08/2021

Introduction

18 months on from the world’s fearful response to the arrival of SARS-CoV-2, we provide an alternative to New Zealand’s elimination strategy to one of ‘living with covid-19’. We are now back in level four lockdown indefinitely with escalating PCR positive ‘cases’. We urgently need to reassess New Zealand’s elimination strategy and whether it makes sense given the new information.

The revised strategy takes account of five major developments over the period:

  • The infection is far less threatening than originally forecast by authorities, including New Zealand, when they proposed lockdowns and other restrictions. Data from the WHO, CDC and other peer-reviewed studies show the median infection fatality ratio (IFR) is ~0.23%, not the projected 3.6%. The condition is therefore more akin to pandemics in 1957 and 1967 than influenza in 1918. Asymptomatic individuals do not spread the infection, removing the key idea underpinning lockdowns. Long-term health effects (“long covid”) have not proven any different to or more prevalent that those experienced in the recovery period from existing circulating pathogens.
  • Questions still remain about the accuracy of the polymerase chain reaction (PCR) test used to diagnose ‘covid-19 cases’. The virus remains yet to be isolated, the sequence of the virus was generated in silico (stitched together from computer databases) and many people who test positive are asymptomatic. In addition, the clinical symptoms associated with covid-19 are not unique.
  • It is clear that the average age of death with covid-19 is about the same as our life expectancy (~82 years). Older people are much more likely to die of covid than younger ones.
  • Very rapid development of vaccines and dissemination of these in New Zealand. The vaccines show some evidence of reducing PCR positive cases, but not of prolonging overall survival or reducing transmission. In many countries now with highly vaccinated populations, there are increasing numbers of breakthrough cases. It is now obvious that vaccines will not stop the spread of the condition long term. In addition, clear evidence shows a major increase in post-vaccination deaths and serious injuries.
  • Early treatment protocols are showing promise in the early treatment of cases otherwise destined to be hospitalised.
  • New Zealand’s very low incidence of covid-19, with the apparent absence of community transmission for many months, whereas covid-19 cases occur freely throughout the rest of the world. Now, we are faced with yet another lockdown and an increase in case numbers.

The vaunted elimination objective makes re-engagement impossible without an improved vaccine administered as often as necessary to most of the population.

New Zealand cannot sustain economically or socially the years of border closure, threat of lockdowns, social disruption and government debt, needed to reach this position, if it can be reached at all. We believe, frankly, this to be a utopian pipe dream, but necessitating dystopian government dictates. The fabric of our society will be rent – then restitched to what?

We propose an approach that slowly and carefully manages our entry back into a world where covid-19 exists, and where it can exist in New Zealand without causing unacceptable harm.

Guiding Principles

The risks of mortality following covid-19 infection have been grossly exaggerated. As observed in other pandemics, a high degree of ascertainment bias has occurred that has further exaggerated the importance of this condition in the minds of scientists, decision makers and politicians. This has led to an over prioritisation of the illness above many other health issues. In turn, this exaggerated threat has led to mortality and morbidity from other diseases due to the imposition of lockdowns and disruption of usual medical care.

The economic effects of lockdowns and border closures, leading to unemployment and poverty will lead to further health deterioration that is out of proportion to the threat of covid-19. Consistent evidence also highlights that lockdowns do not limit the spread of infection.

Now, it is important to note that hospital treatment for covid-19 patients has improved considerably during the course of the pandemic and that hospital mortality has declined. Potential treatments are also available to reduce morbidity and mortality include the use of both the micronutrient vitamin D and anti-parasitic and anti-viral drug ivermectin. It is also clear that metabolic disease is an important contributor to death with covid-19, and it also raises risk of death from other diseases. Addressing dietary risks related to metabolic disease is also worthwhile to reduce potential harm from covid-19, such as reducing sugar intake.

These guidelines were inspired from those produced by the group who published pandata.org.

Ongoing pursuit of elimination is risky

New Zealand is the only country in the world now continuing to attempt to eliminate cases. Many countries that were attempting to eliminate covid-19 have now given up, such as Singapore, UK and Australia. It is a dead-end strategy which will leave New Zealand isolated and vulnerable, in a (possibly) covid-free bubble. Even if elimination is possible and the reward warrants the financial and social cost, cases will still exist throughout the rest of the world – endemic for the foreseeable future (hundreds of years). To keep it out, New Zealand will need to retain covid-19 border testing indefinitely. Similarly, lockdowns and tracing and testing have no time limit.

There are three ends to the elimination strategy:

  1. A cataclysmic failure at the border, such as the beginnings of which we are now seeing, or a winter-resurgence within the country, in which infection sweeps quickly through the population. Lockdowns would, like the US and UK, not protect us.
  2. The infection becomes endemic with low levels of circulation and winter peaks, like the varieties of influenza and coronaviruses that circulate. This is likely to take many years. New Zealand would need to decide a point at which it could open.
  3. Future vaccines may be developed to completely interrupt transmission of covid-19. The development of the currently available partially effective vaccines has been the quickest ever, and faster than we imagined. We do not yet have evidence that the current vaccines reduce viral transmission through a population. Given performance to date, this evidence might one day eventuate. But the rest of the world is not trying to eliminate covid-19 and appears satisfied with the imperfect protection of the current vaccines. That makes it uncertain whether there will be a commercial incentive to ever invent such a comprehensively protective vaccine, since the existing ones are not as effective as required to maintain population elimination.

Our belief is that none of these exits from the elimination strategy are palatable.

Instead, New Zealand should prepare for, and carefully manage, the inevitable introduction of covid-19 to New Zealand.

Frequently asked questions

Do new variants and strains (lineage B 1.1.7 or delta) pose an increased risk of harm?

Every virus is thought to have thousands of variants. There are over 100,000 alleged variants for covid-19. The fact that there are new strains is not important. What’s important is their effect. With the UK strain, the claim is it transmits easier. We haven’t yet seen any convincing evidence that new strains are more dangerous.

Has there been increased overall mortality as a result of covid-19?

Yes, there has been increased overall mortality in some countries, but not all. Many countries, such as Malaysia, Cyprus, Costa Rica, Uruguay, Japan, Singapore, Denmark, Finland, Ireland, Luxembourg and Malta have not. Excess death is also statistically associated with the period after lockdowns in between country comparisons and between US states. Since the average age of death is close to our life expectancy in almost every country, much of the excess mortality is likely to be related to displaced mortality, and light influenza seasons in recent years, leaving a high number of people who are frail and elderly. It is also clear that some of the excess mortality was due to responses to covid-19, such as abandoning non-invasive ventilation for intubation and mechanical ventilation and prematurely sending infectious patients from hospital to rest homes. Hospital mortality in New York has now dropped by 70% since the beginning of the pandemic.

Does evidence support the wearing of masks to prevent infection?

The best evidence from a randomised controlled trial, the Danish mask study, couldn’t find any evidence to support mask use, particularly cloth ones, to protect the wearer. That also indicates that they are not preventing transmission. And asymptomatic people are unlikely to transmit the infection anyway.

What is the extent of the economic recession?

Globally, the World Bank is saying we are now facing the greatest recession since World War 2, demand in food banks in New Zealand has doubled or trebled and we have now thrown more than 50,000 adults in New Zealand into the dole queue, since March, when lockdowns and border closures began.

The health effects from the widespread panic over covid-19 has also produced many mental problems. For example, there has been an increase in children hospitalised for eating disorders both here in Auckland and in Melbourne. In the UK, mental health scores have deteriorated.

Does asymptomatic spread occur?

A mass testing study in Wuhan, a city of 10 million residents, identified 300 asymptomatic cases, with no evidence of spread of infection from them.

Are you just scientific outliers?

We might seem a minority in New Zealand, but our approach is the same as the Great Barrington Declaration, a view on covid-19 signed internationally by 15,000 medical and public health scientists and almost 44,000 medical practitioners.  The counter viewpoint signed by supporters of lockdowns only mustered ~4,200 signatories.

The Plan

Brief guide
  1. Offer enhanced protection and treatment for covid-19 to vulnerable people.
  2. End mass testing, contact tracing, quarantine and lockdowns.
  3. Vaccination should be voluntary and with informed consent and transparency of both efficacy and safety data.
Healthcare recommendations
  1. Since approximately half of fatalities worldwide with covid-19 have occurred in people living in rest homes, this should be the focus of protection. Effort should be given to protecting those who are at high risk of fatality from covid-19, which are individuals aged greater than seventy-five years, particularly those living in supported residential care, and those with metabolic health conditions, such as diabetes, obesity and cardiovascular disease. Measures to protect these people could include regular testing of health workers with respiratory symptoms, who have a high level of exposure to vulnerable people. Strong exclusion policies for workers with respiratory symptoms are important. Ensure people with covid-19 are not in contact with vulnerable people during their infectious period. Other measures include:
    1. Minimise the number of nursing home staff a resident is exposed to.
    2. Provide outdoor areas for socialisation of rest home residents where transmission of the infection is likely to be lower.
    3. Enforce strict exclusion policies related to workers or visitors with any respiratory symptoms.
    4. Encourage supplementation of vitamin D and sun exposure for vulnerable people, since trial evidence supports the use of this micronutrient to prevent intensive care admission in hospitalized patients.
  2. End mass testing for the infection and contact tracing. The test should be only used within a clinical context of a characteristic clinical picture, compatible with a lower respiratory infection within hospitalised individuals.
  3. Increase capacity in hospitals and intensive care units to cope with seasonal demands of respiratory illnesses, including covid-19. As stated, early treatment on diagnosis promises to reduce admissions
  4. Cases should only include those who test PCR positive, at a limited cycle threshold value, with compatible symptoms of a respiratory infection.
  5. Deaths from covid-19 should include only those who fulfil the criteria of being an active covid-19 case temporally related to their death, with no other likely competing cause.
  6. Eliminate mask wearing in the community, since evidence does not support their use to prevent infection in the community.
  7. Vaccination should be entirely voluntary with informed consent of the risks and benefits as more information about their efficacy and side effects come to hand. Vaccination for children of school age should be withdrawn since they are not at appreciable risk of covid fatality. Dangers of exposure to the vaccine, particularly to pregnant women, should be made clear and Ministry of Health information updated accordingly. Vaccination passports or any form of discrimination based on vaccination status should be abandoned, since the vaccines do not convincingly reduce SARS-CoV-2 transmission.
  8. Consider the routine use of vitamin D and ivermectin in the treatment of hospitalised covid-19 infection.
Societal recommendations
  1. Abandon the use of either regional or national lockdowns to contain viral spread, since they are unnecessary, economically disastrous and ineffective.
  2. Schools, childcare centres and universities should not be subject to restrictions and face-to-face learning should have no restriction since children are at extremely low risk for covid fatality.
  3. End all restrictions on businesses.
  4. Undergo a phased re-introduction of normal travel across New Zealand’s border. At first, a risk-based approach may be undertaken, as shown in the following web app and accompanying paper, which has been published in the New Zealand Medical Journal. This strategy indicates a method for opening NZ’s border, based on the estimated prevalence of covid-19 infection in the country of the traveller’s origin. This would enable travellers to come from several countries immediately who have a very low prevalence of covid-19. New Zealand should then aim to end travel restrictions completely, should this initial strategy be successfully enacted. In support of such a stance, the European CDC, for example, has now recommended the dropping of covid-19 testing and quarantine across borders.
  5. End the covid-19 elimination strategy in New Zealand. With cases widespread globally, it is clear that such a strategy is neither sustainable nor beneficial from a perspective which considers both the costs and benefits of such a strategy to New Zealand. Eventually, infection is likely to become endemic and part of the usual seasonal respiratory illnesses that affect New Zealanders every year.

Sweden excess mortality lower than most of Europe

In contrast to the harsh, repeated, extended lockdowns of nations such as the UK, Sweden let citizens work out their own approach to Covid19.

The result was a much smaller spike in deaths above normal in 2020 than most of Europe – 0.03%.

https://www.reuters.com/article/us-health-coronavirus-europe-mortality-idUSKBN2BG1R9